MXPA05000219A

MXPA05000219A - Slotted pins guiding knife in a curved cutter stapler.

Info

Publication number: MXPA05000219A
Application number: MXPA05000219A
Authority: MX
Inventors: Anthony Nguyen
Original assignee: Johnson & Johnson
Priority date: 2003-12-30
Filing date: 2005-01-03
Publication date: 2005-08-26
Also published as: US7204404B2; DE602004012055D1; US20050145673A1; EP1550410A3; EP1550410B1; CA2491795C; EP1550410A2; JP2005211651A; DE602004012055T2; AU2004242528B2; CA2491795A1; CN1672646A; ATE387147T1; PL1550410T3; AU2004242528A1; JP4754212B2; ES2300718T3; CN100502796C; BRPI0405849B8; BRPI0405849A

Abstract

A surgical instrument adapted for applying a plurality of surgical fasteners to body tissue includes a frame having a proximal end and a distal end, with a handle positioned at the proximal end. The instrument also includes a cartridge housing and an anvil. The cartridge housing and anvil are relatively movable between a first spaced apart position and a second position in close approximation with one another, and the cartridge housing includes a knife adapted for cutting tissue by moving between the cartridge housing and the anvil. A firing mechanism is associated with the cartridge housing for selective actuation. The instrument also includes a tissue retention feature having an upper member and a lower member maintaining tissue between the cartridge housing and the anvil during treatment, wherein the upper and lower members respectively include channels associated with the knife for guiding it between the cartridge housing and the anvil.

Description

GROOVED PINS TO GUIDE A BLADE IN A CURVED CUTTING MACHINE FIELD OF THE INVENTION The present invention relates to surgical stapling and cutting tools adapted for use in the diagnosis and therapy of pathologies treated by stapled resection. More particularly, the present invention relates to a guided blade for use in a stapling and cutting instrument.

BACKGROUND OF THE INVENTION Stapling and cutting instruments are commonly used in the diagnosis and treatment of pathologies treated by stapled resection. The stapling and surgical cutting instruments provide a mechanism to extend the transluminal exploitation of mechanical suture devices introduced through the anal canal, mouth, stomach and service access. Although surgical stapling and cutting instruments are most commonly used with rectal pathologies, the stapling and surgical cutting instruments can be used in a variety of environments.

Over time, surgical stapling and cutting tools, in particular, short surgical stapling and cutting instruments, have been developed. These instruments generally include a support frame, an anvil attached to the frame of the support and a cartridge housing that carries a plurality of staples. The instruments also include a conductor within the housing of the cartridge, which pushes all the staples simultaneously into the anvil to form the staples to suture together a tissue of generally B-shaped. Additionally, these instruments include approximation mechanisms for moving the cartridge housing from a spaced position of the anvil to accept the tissue therebetween to a closed position, wherein the tissue is held between the anvil and the cartridge housing. Finally, the instruments include a firing mechanism to move the driver forward to form the staples against the anvil. Current surgical stapling and cutting devices have a centrally located blade with at least one row of staples on each side of the blade. It is desirable to obtain a complete cut without a mark or minimum mark (thin strands of fabric joining the two sides of the cut) when the instrument is activated. The knife of the stapling instrument and surgical cut is advanced in conjunction with the staples of the instrument, as it is fired. The blade penetrates a plastic cutting washer during the final stroke. This penetration cuts any tissue between the blade and the washer.

However, this only happens if the blade is aligned with the washer. Therefore, a system is necessary to align the washer with the blade. Said device could guarantee the quality of the cuts and minimize the marking by keeping the fabric inside the blade arc and between the washer and the blade. The present invention provides said guided blade structure.

BRIEF DESCRIPTION OF THE DRAWINGS Figure 1 is a perspective view of the linear surgical stapler according to the present invention. Figure 2 is a perspective view of the linear surgical stapler with the cartridge module removed. Figure 3 is a perspective view of the linear surgical stapler with the cartridge housing moved to an intermediate position. Figure 4 is a perspective view of the linear surgical stapler with the cartridge housing moved to a closed position. Figure 5 is a perspective view of the linear surgical stapler with the firing trigger in a firing position. Figure 6 is an exploded view of the cartridge module.

Figure 7 is a front perspective view of the cartridge module with the retention device secured thereto. Figure 8 is a front perspective view of the cartridge module with the retainer removed. Figure 9 is a rear perspective view of the cartridge module showing the cartridge receiving groove in substantial detail. Figures 10, 11, and 12 show the assembly of the retaining device. Figure 13 is a partial cross-sectional view of the linear surgical stapler in a non-activated orientation. Figure 14 is an exploded view of the pin activation mechanism. Figure 5 is a partial cross-sectional view of a linear surgical stapler with the closure trigger slightly retracted. Figure 16 is a partial cross-sectional view of the linear surgical stapler with the closure trigger almost completely retracted. Figure 17 is a partial cross-sectional view of the linear surgical stapler with the fully retracted closure trigger.

Fig. 18 is a partial cross-sectional view of the linear surgical stapler with the firing trigger and the closing trigger fully retracted. Figure 19 is a partial cross-sectional view of the linear surgical stapler after the surgeon presses the release button. Figure 20 is a partial cross-sectional view of the linear surgical stapler from the release of the closing and firing triggers without returning to a position of the intermediate mechanical brake. Figures 21 to 29 show the insertion of a cartridge module and the removal of the retention device. Figures 30 to 38 show the various steps involved in the activation of the present linear surgical stapler. Figures 39 and 40 are detailed front views of the cartridge housing.

DETAILED DESCRIPTION OF THE PREFERRED MODALITIES The detailed embodiments of the present invention are described in the present description. It should be understood, however, that the described embodiments are only exemplary of the present invention, which can be implemented in various ways. Accordingly, the details described in the present description will not be construed as limiting, but only as the basis for teaching a person skilled in the art how to make and / or use the present invention. Referring to the various figures, a surgical instrument 20 adapted to apply a plurality of surgical insurers to the body tissue is described. The instrument includes a frame having a proximal end and a distal end, with a handle 21 positioned at the proximal end and an end effector 80 positioned at the distal end. The end effector 80 is shaped and sized to support a cartridge housing 121 and an anvil 122, the cartridge housing 121 and the anvil 122 can move relative between a first separated position and a second position in close approximation each. The cartridge housing 121 includes a knife 126 adapted to cut tissue moving between the housing of the cartridge 121 and the anvil 122. The surgical instrument 20 further includes an activation mechanism associated with the end effector 80 and the housing of the cartridge 121 for its selective activation. The instrument 20 also includes a tissue retention feature associated with the cartridge housing 121 and an anvil 122, tissue retention includes an upper pin and a lower pin that holds the tissue within the end effector during treatment, in where the upper and lower pins respectively include grooves associated with the blade 126 to guide it between the cartridge housing 121 and the anvil 122.

Referring to Figure 1, in combination with Figures 2 to 5, a stapling and surgical cutting instrument is shown, in particular, a linear surgical stapler 20, which is designed to staple and cut tissue. The linear surgical stapler 20 has a handle 21 at a first proximal end and an end effector 80 at an opposite distal end. The end effector 80 is curved, according to a preferred embodiment of the present invention. The right and left structural plates (often referred to as "handle plates") 34, 35, respectively, connect the handle 21 with the end effector 80 of the instrument (the left hand handle plate is not shown in figure 1) . The handle 21 has a right hand cover 22 attached to the left hand cover (the left hand cover is not shown in Figure 1). The handle 21 also has a body portion 23 for gripping and maneuvering the linear surgical stapler 20 (see Figures 2 to 5). The end effector 80 is a surgical fastening assembly that includes a cartridge module 120 (see Figures 6 to 9) and a U-shaped support structure 81. The distal end 30 of a closure member 28 is positioned to receive the cartridge module 120. The end effector 80, also includes a safety locking mechanism 180 (best observed in Figure 31) to prevent firing of a cartridge module - pre-fired 120. The cartridge module 120 contains a cartridge housing 121 coupled to an anvil 122. The cartridge module 120 also includes a retaining pin 25, a blade 126, a removable latching mechanism 160, a tissue contacting surface 127, which deploys a plurality of slots containing staples 128 in stepped formation in one or more rows (ie, staple lines) on either side of the blade 126. The staples (not shown) are fired from the cartridge housing 121 against the surface forming the staple 129 of the anvil 122 which faces the contact surface with the tissue 127 of the cartridge housing 121. As will be apparent from the description below, the present linear surgical stapler 20 is designed as a multiple shot device with a replaceable cartridge module 120. However, it should be understood that many of the concepts Fundamentals of the present invention can be applied in the same way to unique firing devices without departing from the spirit of the present invention. The support structure 81 of the end effector 80 is attached to the right and left hand plates 34, 35, respectively, by a shoulder rivet 82 and posts 83, which extend from the support structure 81, within the reception holes in the handle plates 34, 35. According to a preferred embodiment of the present invention, the support structure 81 is formed by means of a single piece of construction. More specifically, the support structure 81 is formed by extrusion, for example, of aluminum with subsequent machining to create the support structure 81 described in accordance with the present invention. By constructing the support structure 81 in this way, multiple parts are not required and the associated manufacturing and assembly costs are substantially reduced. Additionally, it is considered that the unitary structure of the support structure 81 improves the overall stability of the present linear surgical stapler 20. Additionally, the structure formed by unitary extrusion of the support structure 81 provides a reduction in weight, it is easier its sterilization because the cobalt irradiation will effectively penetrate the aluminum formed by extrusion and less trauma to the fabric will be produced based on the smooth outer surface achieved by extrusion. The handle 21 of the linear surgical stapler 20 includes a hand grip 24, which the surgeon grasps with the palm of his hand (see Figures 2 to 5). The hand grip 24 is composed of a right hand cover handle 25 (see figure 1) and a left hand cover handle (the right hand cover handle is not shown in figure 1). A locking trigger 26 and a trigger trigger 27 extend in pivot form from the bottom of the handle 21. The linear surgical stapler 20 illustrated in FIG. 1 is shown with the closing and firing triggers 26, 27 in their positions not activated and with a cartridge module 120 inserted and the retainer 160 removed. Accordingly, the cartridge housing 121 is separated from the anvil 122 for positioning the tissue between the cartridge housing 121 and the anvil 122.

The handle 21 of the linear surgical stapler 20 contains a tissue retention pin activating mechanism 100. The activation mechanism of the tissue retention pin 100 includes a saddle-shaped portion 101 positioned on the upper surface of the staple. handle 21. Manual movement of the portion 101 results in distal movement of the push rod 102. The push rod 102 is coupled to the detent pin 125 of the cartridge module 120. The distal or proximal retraction movement of the push rod 102 results in the corresponding movement of retaining pin 125. The locking pin activation mechanism 100 is also releasably engaged to lock trigger 26 within handle 21, such that the activation of the closing trigger 26 will result in the automatic distal movement of the retaining pin 125, if it has not already been moved. nually to its most proximal position. Referring to FIGS. 2 to 5 briefly, what happens when the cartridge module 120 is loaded and the closing and firing triggers 26, 27 are pressed sequentially to the handhold 24 to activate the effector is illustrated. of end 80 of the linear surgical stapler 20. The linear surgical stapler 20 is loaded with the cartridge module 120, as shown in FIG. 2, and the clamping device 160 is removed. The linear surgical stapler 20 is now ready to receive the tissue as shown in Figure 1.

When the closing trigger 26 is partially depressed to rest in its first mechanical brake position shown in Figure 3, the cartridge housing 121 moves from its fully open position to an intermediate position between the open and closed positions as it is discussed later in more detail. Simultaneously, the tissue retention pin activating mechanism 100 moves the retention pin 125 forward from the cartridge housing 121 through an opening in the anvil 122. In this position, the tissue, which has been placed between the cartridge housing 121 and the anvil 122 can be placed properly, and the tissue retention between the cartridge housing 121 and the anvil 122 is secured. Accordingly, when the closing trigger 26 has been activated to its intermediate position, the cartridge housing 121 and the anvil 122 are correspondingly positioned in their tissue retention positions. When the closing trigger 26 is fully depressed, such that it is adjacent to the forward end of the hand grip 24, as shown in FIG. 4, the tissue contacting surface 127 of the cartridge housing 121 and the surface that forms the staple 129 of the anvil 122 are adjacent to each other, and the fabric is properly placed and retained, as a result, it is fully stapled.

Additionally, the firing trigger 27 has rotated counterclockwise toward the handhold 24 to allow the surgeon to grasp the firing trigger 27 for firing the staples. Accordingly, the firing trigger 27 is now in position for the surgeon to press to staple and cut the tissue. When the firing trigger 27 has been fully depressed to fire the staples, as shown in Fig. 5, the firing trigger 27 rests in close proximity to the closing trigger 26. Referring now to Figs. 6 to 9, a more detailed description of the cartridge module 120 is presented. The present cartridge module 120 provides a cutting and sealing mechanism for use within the linear surgical stapler 20, wherein the stapling and cutting functions operate in the same direction during the activation of the device. Although the cartridge module has 120, it is adapted in a particular way to be used in conjunction with the linear surgical stapling devices, the concepts of the present cartridge module 120, can be applied to other surgical devices without departing from the spirit of the present invention. In particular, the present cartridge module 120 allows the blade 126 to be used in conjunction with a corresponding washer 123 during the cutting procedure. The present cartridge module 120 ensures that multiple perforations of the linear surgical stapler 20 will not compromise cutting performance. This is achieved by incorporating the anvil 122, in particular, the cutting wash 123, with the cartridge module 120. By combining the washer 123 with the cartridge module 120, a new washer 123 is provided each time the cartridge module 120 is replaced, resulting in improved cutting performance. The improved performance is further provided by placing the anvil 22 and the cartridge housing 121 parallel, such that they move relative to each other with the surfaces facing the anvil 122 and the cartridge housing 121, maintained in a parallel orientation. This is provided for a uniform distribution of pressure through the tissue, preventing oppression of the tissue in a shape, which could group the tissue and force the portions of the tissue, out of the desired spacing defined between the anvil 122 and the cartridge housing. 121. More specifically, the cartridge module 120 includes a cartridge housing 121 that contains a plurality of staples (not shown) positioned in slots containing staples 128. Immediately below the staples is a conductor 131, which is positioned for pushing the staples out of the staple slots 128. A knife holder 130 is immediately positioned proximally to the conductor 131 in the cartridge housing 121. The knife holder 130 contains a slot 172 and a flange 173 for interaction with a hook blade retractor 45 (see figure 37), the function of which will be discussed later in greater detail. The blade holder 130 is attached to a blade 126 that extends distally! from the blade holder 130 through a slot 200 in the conductor 131 and through a slot 199 in the cartridge housing 121.

The blade holder 130 has a mechanical brake post 138 that extends through a slot 137 in the cartridge housing 121. The mechanical brake holder post 138 is positioned to make contact with the protrusion of the mechanical brake 139 of the slot of the cartridge 137 during the longitudinal travel of the blade 126 and the blade holder 130. Similarly, the conductor 131 has a mechanical brake post 40 which is positioned to make proximal and distal contact with the protuberances of the mechanical brake 141, 142, respectively, of the groove of the cartridge 137. The blade 126 and the grooves 199, 200, are positioned such that there is at least one row of staples on either side of the blade 126. According to one embodiment Preferred of the present invention, two rows of staple slots 128 (and two rows of staples) are provided on each side of the slot 99 of the cartridge housing 121. The housing the cartridge 121 contains two generally circular openings 143, 144 at either end of the slot of the blade 199. The general circular opening 143 in the base of the housing of the cartridge 121 has the shape and is dimensioned for the passage of a guide pin 124 to through the housing of the cartridge 21. The generally circular hole 133 in the upper part of the housing of the cartridge 121 has a shape and is dimensioned for the passage of a retaining pin 125 through the housing of the cartridge 121. The stapler grooves 128 are disposed in such a manner that the staples extending laterally to pass the generally circular holes 143, 144. According to a preferred embodiment of the present invention, the anvil 122 includes a plastic washer 123 and a metal surface forming staples 129. The anvil 122 is positioned to maintain the surface forming the staples 129 in a matching configuration. The latching pin 125 is connected to a coupler 133 by a circumferential groove 135 in the latch pin 125 and a slot 134 in the coupler 133 (best seen in Fig. 14). The coupler 133 is positioned within an arm 145 of the cartridge housing 121 and is supported on the arm 145 by an end cover 146. The guide pin 124 and the detent pin 125 includes respective slots 147a, 147b (best seen in FIG. 8, 9, 36, 39 and 40) within which are disposed the ends 126a, 126b of the blade 126. The guide pin 124 of the proximal end 148 is connected to the proximal end 149 of the anvil 122. The distal end 150 of the guide pin 124 extends from the cartridge housing 121 and extends through a slot 151 of the anvil 122. A cutting washer 123 is separated on the anvil 122 by means of a slot 152 on the anvil 122 which is fits under a tab 153 in the washer 123. The opposite end 154 of the cutting washer 123 is separated under the anvil arm 155 and is fastened to the anvil arm 155 by a pin 156. In this position, the surface of cut 57 of the washer 123 extends through a slot 151 of the anvil 122. The assembly of the cutting washer 123 anvil 122 traps the guide pin 124 within the opening formed by the anvil groove 151 and the cutting surface 157, thereby operatively connecting the anvil 122 to the housing of the cartridge 121. The retainer 160 is attached to the anvil 122. attached to the cartridge module 120 as shown in FIG. 7 to hold the components of the cartridge module 120 in a desired orientation until insertion into the end effector 80. Returning to FIGS. 6 to 12 in combination with FIGS. 29, the holding device 160 will be described in more detail. The holding device 160 has a slot 161 which is positioned around a protuberance 159 of the cartridge housing 121. The holding device 160 contains an elastic inner spring arm 162 which it is positioned for reciprocating movement within the holding device 160. The holding device 160 includes containment grooves 163, which extend partially around the guide pin 124. The spring arm 162 includes containment grooves 164, which extend partially around the guide pin 124, although they are configured to be oriented in a direction opposite the containment grooves 163. The holding device 160 is placed on the cartridge module 120, <; in such a way that the containment grooves 163, 164, surround the guide pin 124 and trap the retainer 160 on the cartridge module 120. The spring arm 162 includes a disconnect tab 165, which extends downwardly of the retainer 160 under the anvil arm 155. In this way, the retainer 160 can not be easily removed from cartridge module 120, until the cartridge module 120 is properly seated within end effector 80. From proper seating of cartridge module 120 within end effector 80 , the disconnect tab 165 connects the end effector 80 to release it from the retainer 160. In accordance with the preferred embodiment of the present invention, and referring to FIGS. 8, 9, 36, 39 and 40, the round pins upper and lower, that is, the retaining pin 125 and the guide pin 124, extend between the closed adjustment circular openings 143, 144 of the cartridge housing ho 121 and the anvil 122. Accordingly, the guide pin 124 and the retaining pin 125 maintain the housing of the cartridge 121, the anvil 122 and the washer 123 aligned. The guide pin 124 and the retaining pin 125 are provided with slots 147a, 147b and the blade is displaced in the slots 147a, 147b of the guide pin 123 and the retaining pin 125. In this manner, the blade 126 extends to extend completely the distance between the guide pin 124 and the retaining pin, and in fact, extends slightly beyond the distance between the guide pin 124 and the retaining pin 125, because the ends of the blade 126a, 126b are they seat within the slots 147a, 147b of the guide pin 124 and the retaining pin 125.

As mentioned above, the retaining pin 125 operates in a manner very similar to the traditional retention pins in the tissue retention within the end effector 80 before the activation of the staple conductor 131 and the trigger bar 43 of the linear surgical stapler 20. With this in mind, the retaining pin 125 is controlled for movement between the cartridge housing 121 and the anvil 122. The movement of the retaining pin 125 is discussed in more detail below, with reference to the Figures 13 and 14. The combination of the slots 147a, 147b, as well as the retaining pin 125 and the guide pin 124, extend from the housing of the cartridge 121 to the washer 123 and the anvil 122 ensures that the blade 126, will properly strike the washer 123 for a clean cut of the fabric. The guide pin 124 extends permanently through the cartridge housing 121, the anvil 122 and the washer 123. The holding pin 125 can be retracted and advanced only from the cartridge housing 121 and into the washer 123 and the anvil 122 after the tissue has been inserted into the end effector 80 of the linear surgical stapler 20. The advancement of the retention pin 125 traps the tissue between the retaining pin 125 and the guide pin 124. retention 125 and guide pin 124 are pressed against the washer 123, as shown in Figure 32, which maintains the tissue between the blade 126 and the washer 123. As a result, the advancement of the blade 126 along the the slots 147a, 147b of the retaining pin 125 and the guide pin 124 result in the cutting of the trapped tissue. The marking is then minimized by the fact that the blade extends to pass the ends of the washer 123 and into the grooves 147a, 147b in the retaining pin 125 and the guide pins 124. It is desirable to minimize the clearance between the width of the blade and the width of the slot and maximize the distance that the blade 126 extends into the slots on the retaining pin 125 and the guide pin 124. Although the round pins have been described according to a preferred embodiment of the present invention, the pins could be replaced by any form of grooved pin without departing from the spirit of the present invention. For example, and in accordance with an alternative embodiment, the pins may be L-shaped and provide a guided rail for the movement of the blade. The present blade guide structure improves cutting of the tissue by ensuring alignment of the blade 126 and cutting washer 123, while the blade 126 is advancing from the cartridge housing 121 within the washer 123. Additionally, the structure of The blade guide allows the minimization of tissue marks by trapping tissue in the cutting zone and allows the blade 126 to extend to pass the ends of the washer 123.

Referring again to Figure 1 in combination with Figure 2 and Figure 13, a more detailed description of the components of the linear surgical stapler 20 is provided. The linear surgical stapler 20 includes an elongated closure member, with a cross section generally U-shaped, extending from the handle 21 within the surgical fastening assembly of the end effector 80. According to a preferred embodiment of the present invention, the closure member 28 is a molded plastic member configured for the movement and functionality according to the present invention. By manufacturing the closure member 28 from plastic, manufacturing costs are reduced and the weight of the linear surgical stapler 20 is also reduced. In addition, the linear surgical stapler 20 is easier to sterilize with cobalt irradiation since the plastic is easier to penetrate than stainless steel. According to an alternative embodiment, the closure member can be made from aluminum formed by extrusion with the final features machined on the site. Although an aluminum closure member formed by extrusion may not be easy to manufacture as the plastic component, it could still have the same advantages (i.e., component removal, easier assembly, lighter weight, easier sterilization). The distal portion of the closure member 28 passes through the walls 84 of the support structure 81. The distal end is positioned to receive and retain the cartridge housing 121 of the cartridge module 120. The central portion of the closure member 28 it is positioned between the right and left handle plates 34, 35, respectively. The right and left hand lock couplers 36, 37, respectively, are pivotally joined at the right and left proximal ends of the closure member 28 by a first pin of the integral closure coupler 38. At the opposite end closure couplers 36, 37, the lock couplers 36, 37 are pivotally connected to a second integral lock coupler pin 39. The second pin of the integral closure coupler 39 connects the lock couplers 36, 37 to a slotted closing arm coupler 40. Slotted closing arm coupler 40 is pivotally mounted to handle plates 34, 35 of linear surgical stapler 20 on a pivot pin of latch trigger 41. closure 26 descends from the slotted closing arm coupler 40 for pivoting rotation about the pivot pin of the locking trigger 41 towards and away from the hand grip 24. A closing spring 42 The inside of the hand grip 24 of the handle 21 is secured to the slotted closure arm coupler 40 to provide a desired resistance when the surgeon presses the latch trigger 26 toward the hand grip 24, and biases the latch trigger 26. towards the open position. Referring to FIGS. 13 and 14, the components of the latching mechanism of the latching pin 100 will now be described. The handle 21 contains a saddle-shaped portion 101 mounted on the upper portion of the handle 21 for linear movement. . The portion 101 is connected to a post 103 that extends outwardly from a driver of the push rod 104 through the slots 105 (see Figure 2) in the handle 21. The driver of the push rod 104 is restricted of the longitudinal movement along the long axis of the linear surgical stapler 20 through the slots 105. The driver of the push rod 104 is connected to the push rod 102 by a circumferential groove 107 in the push rod 102 that fits Within a groove 108 of the push rod conductor 104. The distal end of the push rod 102 contains a circumferential groove 109 which is connected with a groove 132 in the proximal end of the coupler 133 of the cartridge module 120 (it is observed better in figure 22). The distal end of the coupler 133 contains a slot 134 for interconnecting with a circumferential groove 135 on the detent pin 125. The closure member 28 contains posts 29, which extend laterally on both sides of the closure member 28 within the handle 21. These posts 29 are slidably connected to an L-shaped groove 10 of a joint 1. The joint 11 1 is pivotally mounted to the handle 21 by means of a pivot pin 112 on the joint 11. 1. The link 111 contains cam pins 113 positioned to urge the cam surfaces 114 on the driver of the push rod 104.

Referring to Figure 13 and Figure 37, the components of the shot transmission assembly will now be described. The trigger transmission assembly has an elongated firing bar 43 extending from the handle 21 in a surgical fastening assembly of the end effector 80. The firing bar 43 is positioned within the U-shaped cross section of the member. 6. The distal end of the firing bar 43 extends into the housing of the cartridge 121 and is positioned only proximally to the holder of the blade 130 and the conductor 131. The distal end of the firing bar 43 is attached to a blade retractor 44 having a retraction hook of the blade 45. The firing bar 43 has a rectangular receiving groove 46 in that portion of the firing bar 43 that is housed inside the handle 21 (see figure 13). The first pin of the integral closure coupler 38 extends through the receiving slot 46. The trigger bar 43 also has a section of the proximal end 47. The lower part of the proximal end section 47 of the trigger bar 43 has a sliding surface 48. The proximal end section 47 also has a terminal lateral connecting surface 49 extending from the sliding surface 48. The trigger trigger 27 is pivotally mounted to the handle plates 34, 35, by means of a pivot pin of the firing trigger 50 separated from the pivot pin of the closing trigger 41, such that each of the pivot pins makes a pivotal movement on the axes independently mutually. The firing trigger 27 includes an arcuate coupler of the arched firing trigger 51 extending from the firing trigger 27 in the pivoting coupler of the firing trigger 50 to a peak 52, which rests on the glide surface 48 of the proximal end section 47 of the firing bar 43. Within the handle 21, the firing trigger 27 is attached to the first and second firing trigger arms 53, 54, respectively. The spring arms of the firing trigger 53, 54, support a torsion spring (not shown) on the right half of the firing trigger 43. Finally, a return spring of the firing bar 55 is secured to the lower part of the firing bar. the firing bar 43 on that portion of the firing bar 43, inside the handle 21 to bias the firing bar 43 to its non-activated position. When the closing trigger 26 is depressed towards the hand grip 24, the slotted closing arm coupler 40 and the locking couplers 36, move distally within the receiving slot 46 of the trip bar 43. This distal movement causes the closure member 28 to move distally as a consequence. Likewise, the firing bar 43, moves concurrently distally with the closing member 28 because the first pin of the integral closing coupler 38, to which the locking pins 36, 37 are attached, extends through the receiving slot 46 in the firing bar 43. The mechanism defining a mechanical intermediate closing brake position and releasing the closing trigger 26 from an activated position to its original, non-activated position, will now be described in connection with figure 1 in combination with figures 13 to 20. The upper part of the slotted closing arm coupler 40 has a sliding surface clamp 56 which deploys an intermediate mechanical brake 57 and a mechanical closing brake 58. release 59 slides on the sliding surface clamp 56 and can connect the intermediate and closing mechanical brakes 57, 58. The release bracket 59 has a locking lug 58 which extends laterally 60 (better seen in Figure 1) at its distal end. The release support 59 is located inside the handle 21, and is integrally attached to a release button 61, positioned externally of the handle 21. The release button 61 has a rest for the thumb 62, and the release button 61 is pivotally attached to the handle 21 by means of a rotatable release bracket 63. The release button 61 is polarized outward from the handle 21 and, accordingly, the release bracket 59 is biased down towards the sliding surface grip 65 by a release spring 64, which is mounted to the handle 21 by a spring retaining pin 65 and mounted to the release button 61 by a button spring post 66. The slotted closure arm coupler 40 has an arcuate space 67 located between the intermediate and closing mechanical brakes 57, 58. Seated within its arcuate space 67 for movement of rotation is a left-hand turnbuckle 68, connected integrally to a right-hand turnbuckle (the right-hand turnbuckle is not shown). Each tensioner 68 has a tension arm 69 which can be connected with the support lug 60. The support lug 60 has a concave proximal surface 70 to provide a gap between the tensioner arm 69 and the support lug 60. Referring to FIG. to figure 31 (a sectional view within the cartridge and support structure), the components of the locking mechanism of the fired device 180 will now be described. The locking mechanism 180 contains a locking lever 181 which is mounted in the form of pivoting the distal end 30 of the closure member 28 by means of a pin 182. The locking lever 81 is a spring biased downward toward the base of the support structure 81 by a spring (not shown). The locking lever 181 contains a proximal end and a distal end 184, 185, respectively. The proximal end 184 has a cam surface 186 and a locking groove 187. The support structure 81 of the end effector 80 contains a flange 85 which is positioned to interact with the locking groove 187, when the locking mechanism 180 is engaged. connected. The support structure 81 contains a base surface 86 between the walls 84. The base surface 86 is positioned to interact with the cam surface 186 when the lock lever 181 is not connected. The loading operation of the cartridge module 120, the closing mechanism, the latch pin mechanism, the trip transmission assembly, the intermediate and closing mechanical brakes 57, 58, the release mechanism and the mechanism will now be described. 180. With reference to Figures 7 to 12 and Figures 21 to 28, the loading of the cartridge module 120 into the tissue end effector 80 is described. The cartridge module 120 is shaped and sized for insertion and selective removal of the tissue end effector 80 of the linear surgical stapler 20. Prior to insertion of the cartridge module 120 into the end effector 80 of the linear surgical stapler 20, as seen in FIG. 7, the device retainer 160 can not easily be removed from the cartridge module 120 as the slot 161 is positioned around the protrusion 159 at the upper end of the retainer 160 avoiding disconnection. Additionally, the containment grooves 163, 164 of the retention device are positioned around the guide pin 124 at the bottom of the retainer 160 preventing disconnection as shown in Figure 25. The attached retainer 160 provides support to the structure of the cartridge module 120 and a surface area that was extended for stapling, both characteristics make loading easier. The retainer 160 also prevents the staples from moving out of the cartridge housing 121 during casual handling and prevents the blade 126 from being exposed accidentally during casual handling. The movement of the blade 126 and the movement of the staples is further resisted before loading and during loading by a series of mechanical brakes. Referring to figure 9, the mechanical brake post 138 in the blade holder 130 prevents proximal and distal movement by the protrusion of the mechanical brake 139 in the groove of the cartridge housing 137. The driver 131 prevents distal movement due to casual handling and during the loading the cartridge module 120 into the linear surgical stapler 20 by interacting the mechanical brake post 140 and the protrusion of the mechanical brake 141 in the groove of the cartridge housing 137. The cartridge module 120 is loaded in the tissue effector 80 , such that the cartridge housing 121 is separated within the distal end 30 of the closure member 28 as seen in Figures 21 to 24. The walls 31 a and 31 b in the closure member 28 are separated within the slots. 170a, 170b of the cartridge housing 121 during loading. Simultaneously, the tabs 174 (see Figure 8) are separated within the slot 88 of the U-shaped support structure 81. The loading of the cartridge module 120 is completed when the mechanical brake 171 is snapped onto the mechanical brake slot 32 of the distal end of the closure member 30, as shown in Figures 21 to 24. In the position shown in Figure 24, the cartridge module 120 is fully charged and the proximal slot 132 of the coupler 133 The distal circumferential groove 109 of the push rod 102 has been connected in such a manner that the retaining pin 125 in the module of the cartridge 120 has been connected to the advancing mechanism of the retaining pin 100. The slot 172 of the blade holder 31 connects the retracting hook of the blade 45 during loading, such that the hook 45 has the retraction flange 173 connected to the blade holder 130 when completing the loading of the module. cartridge 120. Upon completion of loading of the cartridge module 120, a post 188 placed on the lead 131 contacts the distal end 185 of the lock lever 181 (see Figure 31). This contact pivots the locking lever 181 on the pin of the locking lever 182 to a position, such that the cam surface 186 is aligned horizontally with the base surface 86 of the support structure in the form of U 81. The retention device 160 can now be removed from the end effector 80. Specifically, completing the loading of the cartridge module 120 causes the disconnect tab 165 to contact the support structure 81 (see figure 23), which results in an upward movement of the spring arm 162, when the cartridge module 120 is fully loaded as shown in figure 24. This upward movement displaces the containment grooves 164 upwards, so that the guide pin 124 no longer contains it (see figures 25 and 26). Referring now to Figures 27 to 29, a removal force that is applied to the thumb pad 166 results in the retainer member 160 being pivoted outwardly on the protrusion 159 until the slot 161 has the ability to separate the protrusion 159. Removal of the retainer 160 allows the loaded stapler 20 to be used. In Figure 15, the closing trigger 26 has been partially depressed from its opening, the non-activated position is illustrated in Figures 1 and 13. When the closing trigger 26 is partially depressed, it makes pivot movement on the latch pin of the latch trigger 41 in a counterclockwise direction toward the handgrip 24. As the latter handles the pivot movement, the slotted latch arm coupler 40 and the latch couplers the closing plate 36, 37 move forward, consequently moving the closing member 28 and the firing bar 43 distally. As the slotted locking arm coupler 40 moves forward, the lug of the support 60 of the release support 59 slides on the clamp of the sliding surface 56. The support lug 60 connects to the distal ends of the tensioner arms 69 of the tensioners 68, and consequently moves as pivot the turnbuckles 68 in a clockwise direction. As the slotted arm lock coupler 40 continues to move forward in response to the pivotal movement of the lock trigger 26 toward the hand grip 24, the support tab 60 of the release bracket 59 will eventually be housed within the brake intermediate mechanic 57. Once placed on the intermediate mechanical brake 57, the closing spring 42 does not have the ability to return the closing trigger 26 to its original non-activated position. The closing trigger 26 is now in its intermediate, partially closed position, to the proper position and to retain the tissue between the cartridge housing 121 and the anvil 122, as shown in Figure 15. Additionally, according to the closure member 28 and the firing bar 43 moves distally, the peak 52 of the arcuate firing trigger coupler 51 slides on the sliding surface 48 of the proximal end section 47 of firing bar 43. During the closing stroke from the open position to an intermediate position the detent pin mechanism 100 is activated. The forward movement of the closure member 28 moves the integral posts 29 distally. The posts 29 make contact with the L-shaped groove 110 of the joint 1 1 1. Therefore, the distal movement of the cam posts 29 of the L-shaped groove 110 causes the joint to pivot about the pins 112. The rotation results in the connecting posts 113 in the joint 11 1 in contact with the cam surfaces 114 in the push rod conductor 104. The additional rotational movement of the link 111 causes the connecting posts 1 3 to move the driver of the push rod 104 distally through the contact of cam on the surfaces 114. The driver of the push rod 104 makes contact with the push rod 102, moves the push rod 102 distally. The push rod 102, in turn, moves the coupler 133 and the retaining pin 125 distally. The termination of the closing stroke to the position of the intermediate mechanical brake 57 results in the retaining pin 125 moving distally through the hole 144 of the housing of the cartridge 121, the groove of the anvil 151, the hole in the washer 170 and inside the hole 89 (not shown) in the support structure 81. The tissue, which is positioned between the contact surface 127 of the cartridge housing 121 and the anvil 122, is now caught between the retaining pin 25. and the guide pin 124. The same result can be obtained before closing by manual distal movement of the saddle portion 101. The sliding movement will result in the forward movement of the push rod 102, the coupler 133. and the retaining pin 125 until the retaining pin 125 is completely positioned through the anvil 122, the washer 123 and the hole 89 in the support structure 81. activating the closing stroke after the retaining pin 125 that has been manually moved forward could still result in the rotation of the joint 1 1 as described above, but without any additional movement of the pin activation mechanism of retention 00. The closing stroke of the open to intermediate position of the mechanical brake 57 moves the locking lever 181 distally as it is attached to the closure member 28 by the pin 182 as shown in Figure 31 (open) and figure 32 (intermediate position). The distal movement of the locking lever 181 causes the cam surface 186 to contact the locking flange 85 of the support 81., resulting in the locking lever 181 rotating clockwise and engaging that can be slid with the base surface 86 of the support structure 81. In this position, the distal end 185 of the locking lever 181 has rotated away from the post 188 in the conductor 131. Referring now specifically to Figure 16, when the closing trigger 26 is pressed towards the hand grip 24 from the intermediate mechanical brake position 57, the Tension arms 69 of the tensioner 68 are disconnected from the support beam 60. Accordingly, as the tensioner 68 continues to rotate clockwise, the release support tab 60 drives the tensioner arms 69 and with continued movement the closing trigger 26 falls inside the mechanical closing brake 58. As the release support 59 drives the tensioner arm 69, it rotates the release button 61 in the direction of the handle s of the watch around the pivot 63. As the release support 60 falls into the mechanical locking brake 58, this produces an audible clicking sound which alerts the surgeon that the closing position has been reached. Additionally, as the firing bar 43 continues to move forward, the tip 52 the arcuate firing trigger coupler 51 contacts the lateral engagement surface 49 of the proximal end section 47 of the firearm 43. Consequently, the firing trigger 27 moves to a position where it can continue to move the firing bar 43 distally to fire the staples after the fabric has been fully secured. When the tip 52 of the arcuate firing trigger coupler 51 moves in connection with the connecting surface 49 of the proximal end section 47, the firing trigger 27 begins to pivot in a direction in the opposite direction from the firing pins. clock hands to the handhold 24 in response to the action of a torsion spring on the right hand side of the trigger 27 (the torsion spring is not shown). The trigger trigger 27 moves as a pivot independently of the pivoting movement of the closing trigger 26, although its rotation in the form of a pivot is blocked until the firing bar 43 has been moved distally to make possible the connection of the trigger. trigger trigger coupler 51 with the terminal connection surface of the firing bar 43. Returning in a specific manner to figure 17, when the closing trigger 47 has been fully depressed and that it is adjacent to the hand grip 24, the support tab 60 at the distal end of the release support housing 59 in the mechanical closing brake 58. In the mechanical locking brake position 58, the tissue has been fully secured between the housing of the cartridge 121 and the anvil 122, and the closing spring 42 does not have the ability to return the closing trigger 26 to its original position. Accordingly, the closing trigger 26 is retained in the position shown in Figure 4. At the same time as the counter-clockwise movement of the closing trigger 26, the firing trigger 27 continues to rotate in the opposite direction to the clock hands by twisting the return spring of the firing bar 55 until the firing trigger 27 is in a relatively vertical orientation with respect to the handle 21 of the linear surgical stapler 20. In the fully clamped position , the tip 52 of the arcuate firing trigger coupler 51 has completely connected the connecting surface of the proximal end section 47 of firing bar 43, and consequently, firing trigger 27 in a position to further move the rod of shot 43 distally to shoot the staples inside the tissue. In the fully closed position, the staple bags 128 of the cartridge housing 121 are aligned with the surface forming the staples 129 of the anvil 122, as shown in FIG. 33. The retaining pin 125 has aligned the upper part of the anvil 122 and the housing of the cartridge. cartridge 121 and guide pin 124 have aligned the bottom of cartridge housing 121 with the bottom of anvil 122. As illustrated in figure 18 and figure 34, the trigger 27 can be depressed to rotate the pivot towards the hand grip 24 until it is positioned adjacent to the latch trigger 26. During the pivotal rotation of the trigger 27, the firing bar 43 moves in shape distal, makes contact with the blade holder 130. The distal movement resulting from the blade holder 130, results in contact with the blade 126 and the conductor 131. The distal movement of the conductor 131 results in the staples ( not shown) are advanced distally within the surfaces forming the staple 129 of the anvil 122 resulting in the formation of staples generally in a form of B. The blade 26 advances distally in the grooves 147 of the guide pin 124. and the retaining pin 125 in conjunction with the staple formation. These grooves 147 guide the blade 126 on the cutting surface 157 of the cutting washer 123, resulting in the cross section of any tissue caught therebetween. The manual pressure release for the firing trigger 27, results in the return spring of the firing bar 55 retracting the firing bar 43 and returning the firing trigger 27 to the position shown in Figure 17. This movement as a result the retracting hook 45 is retracted onto the retraction housing 173 in the knife holder 130 and the knife 126. The resulting proximal movement retracts the knife 126 into the cartridge housing 121 as shown in Figure 35. The mechanical brake post 138 in the blade holder 130 is retracted in connection with the mechanical brake 139 on the cartridge housing 121 to hold the blade holder 130 and the blade 126 in this retracted position. The conductor 131 is retained in its most distal (fired) position by connecting the locking post 140 on the conductor 131 by connecting the mechanical brake 142 of the slot of the cartridge 137. If there is an interference on the blade 126, as of the user cuts in another surgical instrument by mistake, in such a way that the force of the return spring of the firing bar 55 is not sufficient to retract the firing bar 43, and in this way retract the blade 126 in the cartridge housing 121, the user can manually retract the cutting system by pulling clockwise the trigger trigger 27. Manual movement in the clockwise direction causes the trigger 51 coupler to rotate in the direction of clockwise. the hands of the watch until it hits a pull tab of the firing bar 71 at the proximal end 47 of the firing bar 43. The contact between the trigger coupler Armed trigger 51 and the retract tab of the firing bar 71 cause the firing bar 43 to retract proximally and return to the position shown in Figure 17. This, in turn, causes the retraction hook 45 retracts into retraction housing 173 over knife holder 130 and knife 126. Accordingly, this safety feature allows the user to retract the cutting mechanism to a safe position and return the trigger system to a position that could allow the linear surgical stapler 20 to be opened as will be described below. Referring to FIG. 19, when the surgeon presses the release button 61, the release bracket 59 moves in a pivotal fashion around the rotating support button 63, in a clockwise direction to dislodge the support tab 60 from the mechanical locking brake position 58. As it is dislodged, the support tab 60 leads over the arms of the tensioner 69 to deflect the position of the intermediate mechanical brake 57 in the clamping coupler 40. In this way, the closing and firing triggers 26, 27, may return to their original non-activated positions in response to the bias created from the closing spring 42 and the return spring of the firing bar 55. When the support lug is moved 60 in the arms of the tensioner tensioner 68, the arms of the tensioner 69 rotate in an anti-clockwise direction as the closing and firing triggers 26, 27 rotate in a clockwise direction to return to their original non-activated positions. Accordingly, the surgeon can release the closing and firing triggers 26, 27, so that they can return to the positions illustrated in Figure 20 without unnecessarily returning to the intermediate position of the mechanical brake 57. The release of the linear surgical scraper 20 for the open position shown in Figure 20 causes the closure member 28 and the attached locking lever 181 to retract to the fully open position as shown in Figure 36. In this position, the post 188 in the driver 131 is no longer positioned to hold the distal end of the locking lever 185. The driver 131, as described above, has been mechanically braked in place in the forward position by the post 140 and the mechanical brake of the cartridge 1 2. Therefore, when the locking lever 181, whose proximal end 184 slides along the surface of the support arm 86 is completely retracted, then is free to rotate counterclockwise and fall into the locking slot 187 below the housing 85 on the U-shaped support structure 81. The locking lever 181 will remain in this position when the module cartridge 120 is removed as shown in figure 37. Any subsequent attempt to close the linear surgical stapler 20, which has been fired, will result in the locking groove 187 engaging the housing 85 as shown in figure 38, providing feedback to the user of a previously triggered device. This same feature will be applied if the holding device 160 has been removed prior to loading and the cartridge module 120 has been loaded in the wrong way without the cartridge module 120 being in the proper position. In this case, the driver post 88 may not be in the correct position to move the lock lever 181 in the position to be positioned by the cams on the surface 86 as described above. Similarly, the cartridge module 120, which has already been fired, could also not release the locking mechanism 180. It is important to note that there is a displacement of the allowed closing stroke in the locking mechanism 180 before the connection of the locking groove 187 engaged in the housing 85. This displacement indicates to the user that the device is not jammed due to a malfunction such as the reaction could be if the locking mechanism 180 has not been displaced. Therefore, the user knows that the device is not jammed unless it has been loaded incorrectly when the locking mechanism is connected.After releasing the device back to the open position shown in Figures 1 and 2, the latch pin mechanism 100 must be manually retracted by pushing it proximally on the saddle 101. Retraction causes the latch pin 125 retracts back into the housing of the cartridge 121. Upon completion of the manual retraction of the fired cartridge module 120 it can be discharged and replaced with a new cartridge module 120. Although the preferred embodiments have been shown and described, it will be understood that there is an attempt to limit the present invention by said description, but instead, it is intended to cover all the modifications and to alternate the constructions that are within the spirit and scope of the present invention.

Claims

NOVELTY OF THE INVENTION CLAIMS

1. - A surgical instrument adapted to apply a plurality of surgical fasteners to a body tissue, the surgical instrument comprises: a frame having a proximal end and a distal end, with a handle positioned at a proximal end and an end effector placed on the distal end; wherein the end effector is shaped and sized to support a cartridge housing and an anvil, wherein the cartridge housing and the anvil are relatively moveable between a first separated position and a second position in close approximation to each other, and wherein the cartridge housing includes a blade adapted to cut tissue moving between the cartridge housing and the anvil; a trigger mechanism that is associated with the end effector and the cartridge housing for selective activation, and a tissue retention feature associated with the cartridge housing and the anvil, the tissue retention includes a top pin and a pin bottom that hold the tissue within the end effector during treatment, wherein the upper and lower pins respectively include slots associated with the blade to guide it between the cartridge housing and the anvil.

2. - The surgical instrument according to claim 1, further characterized in that the upper pin is a retaining pin.

3. - The surgical instrument according to claim 1, further characterized in that the lower pin is a guide pin.

4. - The surgical instrument according to claim 1, further characterized in that the upper and lower pins extend between the housing of the cartridge and the anvil.